NPI | 1548657125 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: TX 112364) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: OK 4357) |
Enumeration Date | 2015-04-21 |
Last Update Date | 2021-09-14 |